New Birth Choices for Moms and Doulas

Pregnant moms and doulas in Nashville have a new option for birth support: Hospital-based doula programs are springing up at a couple hospitals around town. Free doulas?! Whether or not you love the idea, there are a wealth of considerations to be made beyond the price tag.

Doula rates span quite a range, from about $300 to over $1000. To learn more about free-for-families hospital-based doulas, and volunteer doula programs in particular, I checked in with my friend and colleague Alisa Blackwood, a, volunteer in the Woodwinds Health Campus doula program in Minneapolis since 2007.

A mother of two young children, Alisa, 36, is an accomplished birth professional. She’s a certified birth doula, birth photographer, and yoga teacher. She teaches prenatal yoga, postnatal mama-baby yoga, infant massage, and birth story writing workshops. Alisa is a talented journalist as well, and she says her skills as a reporter support her birth work: “When interviewing sources, I take care to listen and to respect their stories. These things are important to my doula work as well.”

Here, Alisa shares why she volunteers, memorable moments, surprising struggles, and why she now volunteers exclusively as a loss doula.

Alisa, you’re a volunteer in a hospital doula program, and have been since 2007. Why did you choose to serve birthing women that way, instead of just as a private doula?

It was a great way to build my doula experience right away, while having the guidance of an amazing doula coordinator who had also worked as a labor and delivery nurse. It was her insight, knowledge, and way of mentoring doulas that drew me in. For many doulas, whether new or experienced, if they have other full-time jobs that don’t allow them to take private clients, this is the perfect fit since you get to choose your 24-hour on-call shift.

How did the program work for you?

Even though the Woodwinds program is a volunteer program, the doula coordinator is quite conscientious about who she hires. She interviews everyone, hires only women who have completed doula training and are working toward certification (or are already certified), and requires a one-year commitment. She doesn’t hire everyone she interviews. Once selected, there’s an orientation to the hospital itself and an expectation to sign up for one 24-hour shift per month. You’re welcome to sign up for more if you like, but that’s the minimum. I’ve taken large chunks of time off after my own babies were born, or for vacations. It’s a flexible situation that can accommodate real life and your private doula practice.

If a birth lasts longer than your shift, you’re welcome to stay [with the mama], but you don’t have to. That can feel difficult as the doula, especially if you’ve really connected with the couple and because we’re trained that you never, ever leave the mother! You never want a mom to feel abandoned. If you can’t stay, you’re expected to bring in the next shift’s doula, introduce her to the laboring couple and work together with some overlap to ease the transition. The one time I had to do that, it worked surprisingly well.

The volunteer program is a wonderful support to doulas, too. We have seasonal meetings or parties to talk, get to know each other, and to privately process our birth work as needed.

{{ It was quite difficult for me in the beginning to walk into a room when a mom was already deep into labor and not have any idea who she was, what she believed about birth or what she was hoping for. … [But] I trust the saying, “The right doula will be at your birth.” }}

One of the truly fulfilling aspects of private doula work is getting to know couples during pregnancy, and then seeing them through their birth experience. Did you miss that with the women you served in the volunteer doula program?

It was quite difficult for me in the beginning to walk into a room when a mom was already deep into labor and not have any idea who she was, what she believed about birth or what she was hoping for. However, I quickly learned how to ease myself into the labor support team. And really, what I’ve learned is that you don’t always need to know much about a laboring mom. You know she wants to feel safe. You know she wants to feel supported. So that’s what you do. You’re kind to her. You encourage her. The rest you figure out as you go. It’s an intuitive process and somehow it works out the way it’s supposed to. I trust the saying, “The right doula will be at your birth.”

It is still difficult for me, however, to not have the opportunity to follow up with the family. We’re not allowed to give out our contact information or ask for theirs, though I think we could visit them in the hospital the next day as needed for either side. The doula coordinator always visits the family and follows up with them, too. The family is welcome to ask for the doula’s contact information (with the doula’s permission) at that time. I’ve received some wonderful thank you notes that way, and that feels like some kind of closure.

How did you create connection when you were meeting mamas for the first time in the hospital?

I quietly enter and wait until there’s a pause between contractions to introduce myself. The nurse or the partner fills me in as much as possible about what’s been going on, and any other necessary details trickle out. I don’t want to take a mama out of her laboring space by talking too much, but I do ask before touching or massaging for the first time. I’ve found that if there’s anything specific she wants me to know, she’ll just say it between contractions. Usually there’s a moment when she’ll open her eyes and really look at me, and in that moment there’s a sort of unspoken invitation or acknowledgment of being with her.

{{ I remind myself that many people who don’t hire a private doula ahead of time either can’t afford one or don’t know what a doula is. I believe all women deserve doula support, so however it comes to her, I want her to have it. }}

What about volunteer doula work was different than you imagined?

Only that I miss having the full-spectrum of care from prenatal visits to postpartum visits. I do get that with my private clients, however. I remind myself that many people who don’t hire a private doula ahead of time either can’t afford one or don’t know what a doula is. After this first exposure with a doula, hopefully she’ll hire one next time! I believe all women deserve doula support, so however it comes to her, I want her to have it.

For the Minneapolis birthing community, what value have volunteer programs like this added?

For the doula community, [the volunteer program] added yet another layer of support for birth workers to get to know each other, and to get to know this particular hospital quite well.

{{ What kept me working on-call at the hospital for five years … was that I simply love birth and love supporting women in birth. }}

What memorable volunteer doula experiences have kept you coming back for 5 years?

The first water birth I attended as a doula was as a volunteer at Woodwinds. I was mesmerized. It was stunning.

What kept me working on-call at the hospital for five years (with breaks for my own extended maternity leave) was that I simply love birth and love supporting women in birth. I take a limited number of private doula clients—a conscious choice I’ve made while my children are still so young—and being on-call at Woodwinds allowed me to continue to attend births even if I didn’t have any private clients in a given month.

At Woodwinds, you’re practicing doula work in a different way, now: focusing on supporting mothers and their partners through the loss of a baby. You describe that as “profoundly transformative” for you; why is that?

When I learned that Woodwinds had an emergency room doula program to support mothers who come in with signs of a possible miscarriage, I knew I’d want to sign up. I went through a grief and loss support training, then began taking call. The hospital’s Spiritual Care department handles these calls during the day, so we’re on-call only overnight and on the weekends.

Handling death isn’t easy for everyone, especially when it comes to the death of a little one, but by supporting my father through his death seven years ago, I began to see that the transition into, and the transition out of this world are not so dissimilar. Support, comfort, and love are wanted at both ends of the spectrum. And if a mother ever needed support and a caring person to acknowledge what she’s going through, it’s during the loss of a baby. Because it’s often not only the baby that’s lost, but hopes and dreams, too—a piece of her heart.

One of the most difficult, yet rewarding times in the ER was the work of wrapping a sweet, deceased 16 week old (gestation) baby in a blanket to introduce him to the mama who decided to “look at it” before being discharged. She went from being distraught and frightened, to owning the sadness, yet softening into a bit of peace. She said out loud with much surprise and sweetness, “He’s beautiful!” She went from nurturing life, yet not being able to feel the baby inside her, to seeing that she created life. She birthed. She crossed that threshold into motherhood. And in saying hello to him, rather than thinking of him as a bunch of early cells and tissues, she was more readily able to say goodbye.

To be present for that kind of life-altering event is transformative for everyone in the room. All I can do is hold space for that woman and her family and allow whatever it is they need to come forward. Some women don’t want to see the baby, or it’s too early to see it, and that’s okay, too. It all goes back to supporting the woman in what she needs. It’s her journey, not mine. Some women are even relieved at having a miscarriage. I never know what the backstory is unless the family tells me, so I come in not assuming it’s going to be a sad situation. It isn’t always. Either way, I internally acknowledge this tender, small being and send a little love its way.

Here in Nashville, we’re starting to see hospital-based doula programs (volunteer and paid). Doulas are feeling both curious and concerned. As a doula, how did you feel about these kind of doula offerings?

Some doulas really bristle at volunteer doula programs, arguing that by not compensating the doula, you are not validating her work, and you’re driving down the community’s overall willingness to pay for private doulas. I get that, and have struggled a bit with that argument myself. We’re fortunate in the Twin Cities that there is plenty of paying doula work to go around. There are a ton of hospitals. My personal feeling is that if a family uses a volunteer doula, they had a reason for not hiring privately. Either they didn’t know about doulas beforehand or didn’t feel like they could spend the money.

What guidance or encouragement would you offer to doulas considering working with a volunteer program?

Ask yourself what benefit you will gain from the volunteer program: Ease of scheduling? A community of other doulas? Guaranteed births of all types to expand your experience and/or help you finish your certification? What benefit to the mamas will there be?

{{ Though the volunteer may be fabulous, if she’s already been called in that day and there isn’t another doula on-call, then the mom doesn’t have a doula. }}

What do families need to know about volunteer doula offerings?

There are downsides for the family who chooses not to hire a private doula and only go with a volunteer. Though the volunteer may be fabulous, if she’s already been called in that day and there isn’t another doula on-call, then the mom doesn’t have a doula. It’s a risk the family takes by not hiring privately.

Alisa, thank you for sharing your time, your experience, and your wisdom! You’re a blessing to birth advocates and mamas alike! For women in Minneapolis and St. Paul who might want to connect with you, how can they find you?